PB2667: AUTOIMMUNE DISEASES REVEALED BY SPLANCHNIC THROMBOSIS
Authors: Amine Laabichi, Wafa Ammouri, Nouha EL Waragli, Naima Moutassim, Soukaina Haidouri, Hajar Khibri, Hicham Harmouch, Mouna Maamer, Zoubida Tazi-Mezalek, Mohammed Adnaoui
Journal: HemaSphere (2023)

Topic: 34. Thrombosis and vascular biology - Biology & Translational Research Background: Splanchnic venous thrombosis (SVT) is an unusual site of thrombosis whose incidence is much rarer than conventional thrombosis site (lower limbs and pulmonary embolism) and differs from the latter epidemiologically as much as etiologically. Aims: The objective of our study is to describe the autoimmune pathologies involved in this unusual seat thrombosis and to make its clinical-paraclinical description. Methods: This is a case study series, monocentric, carried out in the Department of Medicine A of the CHU d’Avicenne, over a period of 12 years, between 01/2010 and 01/2022. Results: We collected 12 patients with SVTs who had been explored in the internal medicine department of Rabat’s university hospital, whose average age was 34 years (27-55), with an F/H sex ratio of 2.25. Only one patient had a family history of autoimmune disease and another patient with arterial thrombosis in a parent and siblings, and none had a personal history of thrombosis. The presentation was chronic or subacute in half of the cases and acute in the other half. The telling cause was abdominal pain in 66% of cases (8 patients), other rarer symptoms included lower limbs edema in 8% (1 case), increased abdominal volume in 8% (1 case), and digestive hemorrhage in 8% (1 case), the discovery was incidental in 8% (1 case). The diagnosis was made on an abdominal Doppler echography in half of the cases, and on an abdominal injected CT scan in the other half. Imaging found a thrombosis interesting the portal trunk in 58% (7 cases) and extended to other branches in 41% (5 cases), thrombosis only interested one of its tributarBudd-Chiari (3 cases), and Budd-Chiari syndrome in 16% (2 cases). Blood count indicated isolated iron deficiency anemia in 16% (2 cases), associated with pancytopenia in 16% (2 cases), and normal in 68% (8 cases), biological assessment found hepatic cytolysis in 33% (4 cases), cholestasis in 50% (6 cases) and the combination of both in 25% (3 cases). The cause was anti-phospholipid syndrome in 41% (5 cases), of which 40% (2 cases) were associated with lupus, 40% (2 cases) were primitive and 20% (1 case) were associated with a protein C mutation, other causes were: Behçet disease 16% (2 cases), celiac disease 16% (2 cases), Biermer disease 8% (1 case) and ANCA vasculitis 8% (1 case). All patients were put on anticoagulant treatment, in addition to etiological treatment depending on the found pathology, The liver transplant was offered to a patient who had Stage II complicated cirrhosis of varicose veins with hepatocellular insufficiency at the time of diagnosis. Summary/Conclusion: SVT is an unusual seat thrombosis, requiring exhaustive exploration in search of an underlying etiology of which it may be the first manifestation. The most incriminated connectivities and vasculitis include: SAPL first, which is consistent with the results of our study, other causes including inflammatory bowel disease, and Behçet’s disease are reported at different rates in different studies. Keywords: Venous thrombosis, Autoimmune disease